Is my son being poisoned?

April 1, 2007 6:42 PM

Should my kids be taking fluoride supplements?

I just found out today that my four-year-old son's pediatrician has prescribed daily sodium fluoride pills. The reason given is that we have a well at our house, and he is not getting enough fluoride in his drinking water.

Recommending fluoridated toothpaste or a fluoride treatment at the dentist I could understand, but is there any reason whatsoever he should be taking this stuff every day?

My gut reaction here is to immediately find another doctor.

If it makes any difference, he has had a full set of teeth since he was one, and they are all perfectly aligned, white and shiny.

So, hive mind, am I overreacting here?

posted by bh to health & fitness (47 answers total)

Depends on how much fluoride you have in your water. IANAD(entist) but this doesn't sound so unreasonable.
posted by jckll at 6:49 PM on April 1, 2007

I took fluoride pills when I was small. I remember them as being tiny, sugar-flavored, neon-colored deliciousness.

I think they will not harm your child. I think you are overreacting.
posted by that girl at 6:51 PM on April 1, 2007

I took a fluoride supplement every day growing up; I am no worse for the ware. In fact, the pills tasted rather good!
posted by jab at 6:52 PM on April 1, 2007

Our doctor prescribes them as well. We also have a well, and therefore no flouridated tap water.
posted by saffry at 6:52 PM on April 1, 2007

I think you're overreacting. City water as fluoride put into it. Well water does not. Growing up, I remember kids who came from farms were often given fluoride supplements. I ate them because they tasted good and wanted to be included.
posted by SeizeTheDay at 6:54 PM on April 1, 2007

Anecdotal evidence: My brothers and I took fluoride supplements every day as children when we lived in Norway, where the water isn't flouridated. We have really good teeth -- 0-1 cavities on average for the three of us who went through this -- and no negative side effects that I'm aware of.

Our fluoride prescriptions were standard for children throughout the country.

I think you're overreacting.
posted by croutonsupafreak at 6:54 PM on April 1, 2007

My city in Ontario stopped adding fluoride to the water a few years ago, and as far as I know, it's not common to give kids fluoride supplements.

I do remember taking fluoride treatments at the dentist, and at school, even though the water was treated where I grew up.

I'd say you're right in asking for a second opinion, and ask your doctor for as much information as you can.
posted by piper4 at 6:58 PM on April 1, 2007

Thanks, spork. If I am concerned about the amount, not the debate about the usefulness.

I should mention that while our home does not have fluoride, his school does, as does our gym, and numerous other places we visit.
posted by bh at 7:10 PM on April 1, 2007

If I am
posted by bh at 7:11 PM on April 1, 2007

My major city (Vancouver, Canada) does not put fluoride in drinking water. I used a fluoride toothpaste for my son. However, when he reached age 2, he started sucking the oothpaste off and refusing to let me brush his teeth. I was only using a pea-sized amount, but two friends who are doctors and parents of same-aged children told me that eating toothpaste can be harmful.

I have since switched him to a non-fluoride toothpaste called Tom's Natural. It isn't a children's toothpaste -- I didn't want something with saccharin in it. (Saccharin is not allowed in food products in Canada and my doctor friend said to avoid it in toothpaste, too.)

However, so that he still gets fluoride, I give him a toddler's fluoride tablet once a day. He actually will be very patient with toothbrushing now, since he looks forward to getting the little car-shaped tablet.

My husband grew up on well water and did not receive fluoride tablets. He has a mouth full of fillings. So does his adopted brother.
posted by acoutu at 7:13 PM on April 1, 2007

I should note that I also consulted my dentist and doctor. My dentist gives his daughter the tablets. My doctor said it depended on whether my son was eating toothpaste or actually brushing with it.
posted by acoutu at 7:14 PM on April 1, 2007

I took fluoride tablets as a child, and have never had anything approaching a cavity. Your doctor is right.
posted by awesomebrad at 7:16 PM on April 1, 2007

I grew up on non-floridated water and the only fluoride I got was from my toothpaste. 32 years and no fillings. Both my brothers are the same way and we all grew up on candy. Hell, I'm eating Cadbury Creme Eggs right now! :)
MMmmmm....
posted by Thrillhouse at 7:16 PM on April 1, 2007

If your gut reaction is to not give your son fluoride, by all means don't give it to him. I don't think you're overreacting. Fluoride was prescribed for both of my kids (as babies, actually) and I never filled either prescription. They're 21 and 17 now and both have gorgeous teeth, and never have cavities. They had fluoride in their toothpaste and also had occasional fluoride treatments at the dentist, and I saw no reason to treat them with daily meds.
posted by iconomy at 7:20 PM on April 1, 2007

These people seem to be fairly anti-fluoride, and seem to have some medical studies to back up their premise. Here are some reports on fluoride toxicity levels.

(Just to give you a sample of the other side. I have no dog in this fight.) My son uses a fluoride toothpaste for his age group, and our water has fluoride, and he's never had a cavity.
posted by dejah420 at 7:20 PM on April 1, 2007

I would use the fluoride supplements. According to the ADA, you need systemic and topical fluoride to fight cavities. The systemic fluoride that you get from drinking tap water (or supplements, in your son's case) and up in the saliva and provide protection that way. I think people also used to believe that fluoride gets incorporated into the matrix of the tooth and keeps on protecting, though that may not be believed any more.

He's not getting poisoned. Drinking water has been fluoridated for ages now. So there's plenty of safety data.

Anecdotally, I grew up in the suburbs with fluoridated water and don't get many cavities, and my husband grew up in the country with well water and gets cavities all the time.
posted by selfmedicating at 7:30 PM on April 1, 2007

Sorry, "ENDS up in the saliva".
posted by selfmedicating at 7:31 PM on April 1, 2007

And you can look here for the ADA's dosing schedule for fluoride. If you know what the fluoride levels are for your area you can get a sense of whether he's getting overdosed on fluoride. I just read your responses more closely and realized he was getting fluoride outside the home.
posted by selfmedicating at 7:35 PM on April 1, 2007

My siblings and I took fluoride tablets as children, and none of us have ever had a cavity.

I'm super-smart, too, so I wouldn't worry about that either.
posted by Mr. President Dr. Steve Elvis America at 7:40 PM on April 1, 2007 [1 favorite]

What the heck is a fluoride tablet? I had well water growing up, and I never took fluoride tablets. Heck, I didn't see a dentist until I was five. I had a few minor cavities growing up, since I didn't floss at all (and probably could have used some orthodontics to space out my teeth more) but nothing at all major. I really don't think it is a big deal, and I haven't had a cavity in probably 10 years (I've only been drinking fluoridated water for the past 3.)
posted by Loto at 7:49 PM on April 1, 2007

We mostly drink bottled water at home (our tap water is perfectly healthy, but not very tasty for some reason), and our dentist just recommended a fluoride mouthwash for our 5-year-old (we use this one, which she is happy with). Perhaps that is a compromise you would feel OK about?
posted by Rock Steady at 7:57 PM on April 1, 2007

I would get a second opinion, maybe from a dentist instead of another doctor.

Thanks to the same logic your doctor's using -- well water -- I took fluoride tablets as a kid, in addition to fluoridated toothpaste and annual treatments at the dentist's office. On one hand, I've never had any cavities. On the other hand, I do have dental fluorosis; my teeth look like the top image on that page, yellowish with bright-white spots, and I'm really not happy about it. Even a mild case is pretty unsightly.
posted by booksandlibretti at 7:59 PM on April 1, 2007

I wouldn't give my kids fluoride tablets. I would ask your dentist what he thinks, he should be able to examine your child's teeth and see if the enamel is strong or not. If anything wait until he is a little older and get some topical fluoride that you rub onto your teeth and spit out.
posted by trishthedish at 8:11 PM on April 1, 2007

To start, you should know that your doctor is not trying some quack or crackpot idea; rather, he is practicing in accordance with guidelines approved by the American Academy of Pediatrics, the American Academy of Pediatric Dentistry, the American Dental Association, and the Centers for Disease Control. Here is a nice review of the recommendations.

Fluoride treatments only help the surface enamel; ingested fluoride, also called 'systemic' fluoride, strengthens the enamel as it is forming. That is why it is important to use both kinds. Too much fluoride can cause mottling of teeth, but it really takes a whopping amount - far more than are probably present in the pills your doc gave you - to cause this. It's also good to know that even if the teeth become mottled, they are still protected against cavities and dental caries! Frankly I'd rather have 32 mottled teeth than 1 root canal. But the tiny amounts in these pills won't mottle your son's teeth - they'll just make them extremely cavity-resistant.

Dental caries - tooth decay - used to be the #1 killer of human beings. Apart from that, the suffering it causes is tremendous. The CDC listed fluoridation of drinking water as one of the 10 great health advances of the 20th century - this is the century that brought you antibiotics, the polio vaccine and the seat-belt, remember - and I agree with them completely.

There is some paranoia out there about the effects of fluoridated drinking water, probably most famously mocked in the movie Dr Strangelove. In my opinion, you should be aware that these paranoid fears are the quack or crackpot ideas; and whoever casts a vote against water fluoridation is, in my opinion, casting one of most powerful votes imaginable in favor of human suffering.
posted by ikkyu2 at 8:12 PM on April 1, 2007 [5 favorites]

Oh, and one more thing, I have never yet had a doctor (not dentist) that knew anything useful about teeth.
posted by trishthedish at 8:13 PM on April 1, 2007

ikkyu2 - Thanks for the well reasoned response, as always. I should have made it more clear that my concern was the amount, since my son gets plenty of regular tap water.
posted by bh at 8:23 PM on April 1, 2007

A dentist for my children also wanted them to be on daily fluoride pills. This was the same dentist who wanted x-rays every visit and when I objected, it was a major big deal. I had to sign a responsibility waiver and given a lecture about x-rays. I found another dentist. This new dentist has suggested that my children use a fluoride rinse (he also asks my permission to do x-rays) - they rarely do so. They have all also received fluroide treatments at the dentists office - I think those are once a year. The two older children (19 and 16) have no cavities; the youngest (13) has had 4 cavities in baby teeth but he has also been less careful about toothbrushing. From a scientific standpoint, there is some credible evidence against adding fluoride to water -- these are not necessarily paranoid fears and I was cautious in the way I approached this with my children.
posted by bluesky43 at 8:23 PM on April 1, 2007

Then again, I see that you posted a clarification that it was not fluoride you were worried about, but the quantity of fluoride.

Since you did not actually specify what quantity your son was prescribed, though, I do not know how anyone could provide a meaningful answer.

If you cared to look on the bottle label, it will say how many milligrams are in each pill. You could compare that to the recommendations here to get an idea of whether or not the prescribed amount was reasonable. It looks to me like the CDC thinks your son should be taking half a milligram per day.
posted by ikkyu2 at 8:24 PM on April 1, 2007

Like booksandlibretti, I have never had a cavity but I too have mild dental fluorosis from over-flurodiation of the local water when I was little. Of course I'm happy to have healthy teeth, but although I strive to avoid vanity, I truly wish I didn't have to live with the discoloration. Supposedly it can be fixed cosmetically, but my dentist said any whitening can make the color difference more noticable since everything gets lightened.

I Nth getting a second opinion from your dentist just to be sure the quantity is appropriate given your situation.
posted by nelleish at 8:27 PM on April 1, 2007

Indeed, .5mg/day. I did check the standard dosing before I posted this, and I think in my next ask mefi I will be a bit more specific.
posted by bh at 8:34 PM on April 1, 2007

This is purely anecdotal, but my first hand experience.

My town had fluoridated municipal water until I was about 10. At that point, the city switched water sources (well to reservoir) and also stopped adding fluoride.

By age 13, I had 11 teeth with at least 1 small cavity in each. Until then, I had zero dental issues. After that first round of dental work I use a fluoride rinse daily.
posted by braintoast at 8:56 PM on April 1, 2007

I do have dental fluorosis; my teeth look like the top image on that page, yellowish with bright-white spots, and I'm really not happy about it. Even a mild case is pretty unsightly.

I have dental fluorosis also, and I don't have any anxiety over it. As ikkyu2 said, better mottled teeth than root canals. It's really not that awful, and the only reason I have it is fluoride on top of fluoridated toothpaste on top of fluoridated water. Which is not your situation.
posted by ch1x0r at 9:03 PM on April 1, 2007

I have two younger sisters. My mom was very diligent about giving me and the middle sister fluoride tablets when we were young and grew lax by the time the youngest came along. She is the only one of us who has had cavities - and we come from tooth-decaying stock on both sides.
posted by crinklebat at 9:09 PM on April 1, 2007

"Fluoride treatments may be a money-maker for dentists, but there’s no proof it benefits children at low risk for tooth decay."

”Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines,” Am J Prev Med Feb 2000 , by Frame et al
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10698247&dopt=Abstract

IMO Fluoride is a poison and should be avoided. Nothing can replace regular brushing. I don't use toothpaste with fluoride either, rather I prefer Tooth-soap.
posted by Jbgohlke at 9:15 PM on April 1, 2007

Dental fluorosis is a "good" thing in a way, because your teeth are hard and strong and you'll probably end up with very few cavities, blah blah blah, hooray fluoride, but...

I had dental fluorosis ever since I was a little girl (I drank nothing but water and the occasional milk with my cereal), and even though I never had a cavity up until I was 19, I was teased CONSTANTLY and was afraid to smile because the kids all made fun of me for the fluorosis. I got called "dirty teeth," "jaws," all sorts of names. Never mind that I never had dental horror stories like them. I got some cosmetic dentistry done, and now the color is at least even, but growing up with it sucked.

IANADentist, but I'd say have your child brush with fluoride toothpaste regularly, floss, etc. Definitely get that second opinon, too.
posted by Verdandi at 9:49 PM on April 1, 2007

My son's pediatrician and his dentist both recommend fluoride supplements. We skipped it initially, and despite our diligent efforts at brushing, he developed a very bad cavity that put him in a lot of needless pain. So, now we supplement. I wish I had done it sooner.

Others have mentioned it in passing but I wanted to make it clear that one should not assume their municipal drinking water supply (tap water) is fluoridated. Many US municipalities stopped adding it in between the time we were all kids and now...I was pretty surprised to learn my own city (pop. ~900K) does not add fluoride to its water. You can check if your tap water has it by calling the customer service number on your water bill.
posted by jamaro at 11:00 PM on April 1, 2007

I think it absolutely depends on your genetics. I grew up without fluoridated water and my teeth are straight, white and shiny. However, so are my brother's, mother's and father's teeth.

My toothpaste (Burt's Bees) doesn't have fluoride in it. I refuse to use that burning concoction known as mainstream toothpaste!
posted by fujiko at 11:43 PM on April 1, 2007

It really depends where you live. The dental benefits of fluoride were discoverd by epidemiologists who were able to map rates of dental caries against *natural* levels of fluoride in the water. If your local (well, tap) water supplies naturally carry fluoride, then you should not supplement, or not as much. If they do not, then you should.

Your dentist should know these things and know for sure about local tap and well waters, but unfortunately some don't. When I asked one dentist (before I did BSc in Nutrition studies) where we got our fluoride before toothpaste was invented, he paused, looked clueless, and announced "lettuce and things."

If you're really concerned, find out from your local municipality what fluoridation rates are, have your well-water tested, and observe your son for two days during the week and one day over a typical week-end. What does he drink? How much? Where?

You may decide to give the fluoride pill only on even-numbered days of the week. That will probably be plenty anyway. CDC recommendations for populations tend to be on the high side of a reasonable range because they need to think of everybody, including children who only drink pop, and the pop they drink happens to come from a plant which happens to use unfluoridated water. Of course the CDC also has to think of kids at risk for dental fluorosis, so they can't just recommend an extravagant amount either.
posted by kika at 4:42 AM on April 2, 2007

Oh, and no, your son is not being poisoned.
posted by kika at 4:45 AM on April 2, 2007

Straight Dope column on flouride.
posted by Chrysostom at 7:27 AM on April 2, 2007

I've got some mild dental fluorisis. I've got about 12 years on booksandlibretti, if I recall correctly, and I have 1 week now with this temporary crown from my cracked rear molar.

I have long wished my teeth were a slightly more attractive color, but not enough to spend the money on bonding.

I have never wanted that as much as I wanted not to deal with getting this crown.

Answers.com's article on has a table near the end on low and high end quantities of fluoride indate and they list .5mg as half the low-end of intake your 4-year-old son should be taking in and the high end at 2.2, almost 5 tablets worth.

So the question is, given that he is taking in water at non-home locations with a fluoride content that is probably 1ppm, what are the odds that he'd approach/exceed 2.2mg a day? I suspect it's slim to none.
posted by phearlez at 8:27 AM on April 2, 2007

fluoride inTAKE, dammit.
posted by phearlez at 8:27 AM on April 2, 2007

Dental caries, i.e., cavities, are caused by bacteria, and are not necessarily 'natural.' The bacteria has spread with what we call civilization. Poor dental health contributes to heart disease. Do double-check the research, so that you feel confident of the supplement and the dosage, but I would be very surprised if you found credible evidence against fluoridation.

I have fluoride spots on my teeth, but what really looks bad is missing teeth, or toothrot on people who don't get good dental care. Good dental care is also not cheap, as compared to fluoride.
posted by theora55 at 8:34 AM on April 2, 2007

I have gotten the impression that flouride helps with forming the adult teeth that will come in later, and needs to be availible as those teeth form for them to be strong later on.

My younger years were in an area without flouridated water. I would prefer to have mottled looking teeth than wondering how I will pay for all the dental work I need, and wondering if the odd feeling on one side of my mouth means I'll need another root canal sometime soon. This is after having 8 or 10 teeth filled about 8 years back. The front teeth look great, all the trouble is with the back teeth.

Anyone with mottling up for a trade?
posted by yohko at 9:52 AM on April 2, 2007

FWIW, I wish that I had been given flouride supplements as a child.
posted by yohko at 9:54 AM on April 2, 2007

According to this study by the USDA, for kids, the recommended does is 0.05 mg/kg/day and not to exceed 0.10 mg/kg/day. The study shows the amounts of fluoride in various foods and beverages including water.
posted by euphorb at 9:55 AM on April 2, 2007

My kids use them (well water). Oregon communities are full of flouride haters. I also see mouths full of metal every day. It's as contoversial as vaccines, which is to say, not at all, unless you are a proponent of magical thinking.
posted by docpops at 2:39 PM on April 2, 2007